Vestibular testing

sometimes needs to be performed over time.  If a person is not in the midst of a spell when having their vestibular system checked, the result of the test may not always be accurate.  The key to receiving an accurate picture of how well the inner ear is truly working is to test how well it functions on "good" and "bad" days.

Lateral canal cupulolithiasis with vibration

I recently had a client who had ageotropic nystagmus in the head right position that did not fatigue at 3 minutes.  It did abate with fixation, but returned when the fixation light was turned off.  After about 20 seconds of vibration, the ageotropic nystagmus abated.  Upon rolling to her left side she had geotropic nystagmus.  Following 2 360 degree rolls, she no longer had nystagmus in either of the positions.  We finished with one more 270 roll.

What does dizzy mean?

According to the clients I have seen, there are at least 114 ways to describe the sensation.  One of the keys to getting help when an individual is dizzy is for them to be able to describe the different sensations they feel when they are dizzy.  Learning the "dizzy language" helps battle the problem.

"He'll snap your head back and forth"

WAIT!!!  STOP!!!!  No I won't.  A client recently told me she was told I would do this to her to help get rid of her dizziness.  I guess it was part of the motivational talk she received to build up the courage to come and see me for vestibular rehabilitation.

It's funny how we describe experiences.  In my opinion, this language does not represent the type of therapy I do.  Perhaps it is just a matter of semantics.  I don't "snap" heads.  In fact, 99% of the things I do are very gentle.  I think a better way to say it is "he'll turn your head gently in proper directions at the right time."

A hypofunction and hyperfunction all in one ear

does not seem to be all that uncommon.  It becomes more of a challenge when the underlying cause is not in remission.

"I was worried it was all in my head!"

I hear my clients say that usually at least once a week.  So many people who suffer from problems causing spinning are frustrated because the believe others think they are "crazy".  Once we point out that these individuals do have nystagmus and that we can see when their dizziness begins and ends, they are so relieved.  They appreciate being told that their problem is real.  Of course, they appreciate even more having the problem taken away.  So, yes, the problem really is in their head...but it's in their inner ear which is located in their head!

Amplitude and frequency of nystagmus

seems to be directly related to the severity of the vestibular problem.  The higher the frequency and amplitude of nystagmus, the more dizzy my clients seem to be.  Following repeated repositioning attempts, I recently observed severe nystagmus improve to, what seemed to be, 1/10th then 1/20th of a turn of torsion.  This was asymptomatic, however, I still believe it represented the problem still being present (at a much lesser degree).  Sometimes, it seems like the eyes are "loading."   Nystagmus does not occur, but the slow phase seems to begin.